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dc.contributor.authorRaine, R
dc.contributor.authorXanthopoulou, P
dc.contributor.authorWallace, I
dc.contributor.authorNic A' Bháird, C
dc.contributor.authorLanceley, A
dc.contributor.authorClarke, A
dc.contributor.authorLivingston, G
dc.contributor.authorPrentice, A
dc.contributor.authorArdron, D
dc.contributor.authorHarris, M
dc.contributor.authorKing, M
dc.contributor.authorMichie, S
dc.contributor.authorBlazeby, JM
dc.contributor.authorAustin-Parsons, N
dc.contributor.authorGibbs, S
dc.contributor.authorBarber, J
dc.date.accessioned2016-05-04T14:44:04Z
dc.date.issued2014-10
dc.description.abstractOBJECTIVE: Multidisciplinary team (MDT) meetings are assumed to produce better decisions and are extensively used to manage chronic disease in the National Health Service (NHS). However, evidence for their effectiveness is mixed. Our objective was to investigate determinants of MDT effectiveness by examining factors influencing the implementation of MDT treatment plans. This is a proxy measure of effectiveness, because it lies on the pathway to improvements in health, and reflects team decision making which has taken account of clinical and non-clinical information. Additionally, this measure can be compared across MDTs for different conditions. METHODS: We undertook a prospective mixed-methods study of 12 MDTs in London and North Thames. Data were collected by observation of 370 MDT meetings, interviews with 53 MDT members, and from 2654 patient medical records. We examined the influence of patient-related factors (disease, age, sex, deprivation, whether their preferences and other clinical/health behaviours were mentioned) and MDT features (as measured using the 'Team Climate Inventory' and skill mix) on the implementation of MDT treatment plans. RESULTS: The adjusted odds (or likelihood) of implementation was reduced by 25% for each additional professional group represented at the MDT meeting. Implementation was more likely in MDTs with clear goals and processes and a good 'Team Climate' (adjusted OR 1.96; 95% CI 1.15 to 3.31 for a unit increase in Team Climate Inventory (TCI) score). Implementation varied by disease category, with the lowest adjusted odds of implementation in mental health teams. Implementation was also lower for patients living in more deprived areas (adjusted odds of implementation for patients in the most compared with least deprived areas was 0.60, 95% CI 0.39 to 0.91). CONCLUSIONS: Greater multidisciplinarity is not necessarily associated with more effective decision making. Explicit goals and procedures are also crucial. Decision implementation should be routinely monitored to ensure the equitable provision of care.en_GB
dc.description.sponsorshipThis project was funded by the NIHR Health Services and Delivery Research programme (project number 09/2001/ 04) and will be published in full in the Health Services and Delivery Research Journal. Further information available at: (http://www.netscc.ac.uk/hsdr/projdetails.php?ref=09-2001-04). In accordance with NIHR regulations, the findings reported here are to be referred to as initial until the NIHR final report has been published. The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, the writing of the report, or the decision to submit the report for publication.en_GB
dc.identifier.citationVol. 23, pp. 867 - 876en_GB
dc.identifier.doi10.1136/bmjqs-2014-002818
dc.identifier.otherbmjqs-2014-002818
dc.identifier.urihttp://hdl.handle.net/10871/21378
dc.language.isoenen_GB
dc.publisherBMJ Publishing Groupen_GB
dc.relation.urlhttp://www.ncbi.nlm.nih.gov/pubmed/24915539en_GB
dc.rightsThis is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 3.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is noncommercial. See: http://creativecommons.org/licenses/by-nc/3.0/en_GB
dc.subjectChronic Disease Managementen_GB
dc.subjectDecision Makingen_GB
dc.subjectHealth Services Researchen_GB
dc.subjectTeamsen_GB
dc.subjectTeamworken_GB
dc.titleDeterminants of treatment plan implementation in multidisciplinary team meetings for patients with chronic diseases: a mixed-methods study.en_GB
dc.typeArticleen_GB
dc.date.available2016-05-04T14:44:04Z
dc.identifier.issn2044-5415
exeter.place-of-publicationEngland
dc.descriptionThis is the final version of the article. Available from the publisher via the DOI in this record.en_GB
dc.identifier.journalBMJ Quality and Safetyen_GB
dc.identifier.pmid24915539


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